• drafting and revising protocols, and obtaining approval from various committees, boards, and professional and community groups;

  • initial and ongoing education, training, and support for practitioners;

  • community and media outreach and education; and

  • ongoing oversight and review, and ongoing protocol revision.

Each of these steps places demands on hospital and OPO resources, requiring specific attention to how these resources will be made available.

CONSTITUENTS

Development

Take as much time as you need. Put all the adversaries on the committee and they will talk to you in the same room. (J. Light)

I didn’t anticipate that I would have trouble on the surgical side. There is a transplant center in my region that doesn’t have a dedicated transplant surgeon (i.e. someone whose practice is dedicated to transplant only); a vascular surgeon does the surgery in that locale. At three in the morning it’s not going to be easy to get a person to come out, stand there either in the operating room or in the intensive care unit, and await yes or no that the patient is indeed declared dead. (F. Delmonico)

Our biggest surprise was anesthesia. We really didn’t expect the anesthesiologists to give us such a hard time as far as volunteering services to come in and pronounce death. (D. Cornell)

The patient who becomes a non-heart-beating donor comes under the care of physicians, nurses, and other hospital staff in the emergency room (ER), intensive care unit (ICU), and operating room (OR). Staff concerns about non-heart-beating donation arise when the process is not understood fully, or when the staff is not prepared fully for the new responsibilities involved. They arise also when staff members have unresolved ethical, legal or patient care concerns about the non-heart-beating donation process.

In many cases, practitioner concerns can be addressed through early participation in the protocol development process and through education that explains the process of non-heart-beating donation and identifies practitioner responsibilities. They can be addressed also through ongoing education and follow-up during each non-heart-beating donor case.

The challenge is identifying and involving all concerned parties. All of the programs encountered unanticipated resistance, each from different practitioners. Direct communication and education help to clear up misunderstandings and to resolve concerns and issues. Involving all of the concerned parties from start to finish can avert misunderstandings at the beginning of the process.



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